“Uncle Sam,” liberal activist Paul Nickerson of Lewiston, wore a costume as part of a stunt that threw a temporary wrench into the governor’s publicity campaign: the presentation of oversized checks – “Publisher’s-Clearinghouse”-style LePage told the Sun Journal in Lewiston – to Maine’s hospitals.

LePage has repeatedly said that a policy and political priority is repaying the state’s $183 million share of a $490 million Medicaid debt to Maine’s 39 hospitals. On Wednesday, the governor went about the business of making good on his word.

However, the governor’s victory tour was disrupted by a political and policy priority of Democrats: the expansion of Medicaid, the public health insurance program for the poor, through the federal Affordable Care Act.

As LePage presented the oversized check to officials at Central Maine Medical Center, Nickerson, an activist from the Maine People’s Alliance, brought the check to LePage. The fake check was from the federal government – a reference to the “federal dollars” that Democratic lawmakers and activists say LePage is forgoing through his resistance to expanding Medicaid to more than 60,000 Mainers.

As the hospital event began, Nickerson entered the lobby wearing his costume. He didn’t speak, but struck a wide stance off to LePage’s right. He stood silently, holding the check and pointing to the crowd – the iconic gesture made by Uncle Sam. LePage laughed initially, as did the crowd of doctors and nurses who lined the hospital entrance on an exposed balcony.

The governor continued with his prepared remarks, saying repaying the hospital debt was one of his proudest accomplishments.

Nickerson, however, was the focus of the crowd. Eventually, Peter Steele, the governor’s spokesman, gestured to a member of LePage’s security detail. Nickerson was escorted out of the hospital without incident. As he left, a man in the crowd muttered to him, “Why don’t you get a job?”

The fight over Medicaid dominated the last legislative session. It promises to continue through 2014, a gubernatorial and legislative election year. LePage launched the first salvo this week, selecting findings in a University of Michigan study to argue that Medicaid expansion would benefit younger men, smokers and those who are likely to consume alcohol.

Although the study was supportive of expansion, the governor’s message was clear: The able-bodied, smokers and drinkers will receive taxpayer-funded health care.

The next day Democratic legislative leaders announced that they would introduce Medicaid expansion legislation in January. It will be their third attempt after failing to convince enough Republicans to support a bill that combined the governor’s hospital payback plan with expansion, and another amended version co-authored by Senate minority leader Sen. Roger Katz, R-Augusta.

“We will never stop fighting for health care for thousands of Maine people,” Democratic House Speaker Mark Eves said during a news conference Tuesday.

Assistant Senate majority leader Anne Haskell, D-Portland, added, “Gov. LePage should join all the other Republican governors who have put aside partisanship and political games to expand health care for the people in their state. Instead, our governor has doubled down his ‘deny and delay’ of expanding health care and he is spreading misinformation and fear, pitting Mainers against each other.”

Wednesday’s stunt by the Maine People’s Alliance was a continuation of the political battle. The nonprofit group supports state Democratic candidates and causes, through voter-registration and get-out-the-vote efforts.

LePage on Wednesday took a few questions from reporters. He initially declined to talk about Medicaid but relented after being pressed on the issue. He said Democrats hadn’t come forward with any meaningful compromise plan and were using the issue for political gain. He said he wouldn’t expand Medicaid until the Legislature funded existed Medicaid services for several thousand disabled residents on a waiting list.

“You can’t pick and choose who you cover for votes,” LePage said. “It’s time to put people over politics.”

The disabled Mainers referenced by LePage receive some Medicaid coverage but are waiting for additional services for which they qualify.

The waiting list is the subject of a court action filed May 28 that effectively compelled the LePage administration to cover qualified recipients. Lawmakers authorized $10.4 million in the state budget to draw down the waiting list, but more funds are needed.

Later during the event, MPA activist Marie Pineo of Yarmouth told LePage that she was going to lose her health care coverage if LePage didn’t go along with expansion. Pineo held a letter from the state saying her coverage would expire Jan. 1, 2014.

The governor asked Pineo if she had a job. She said she did. He told Pineo that she could still qualify for coverage through subsidies in the Affordable Care Act, that most of her insurance costs would be paid for.

Pineo, surrounded by reporters after the event, later said that she wasn’t sure if she’d qualify for the subsidies.

Expansion would broaden MaineCare, the state’s Medicaid program, to cover adults without children who earn under $15,856 a year. Eligibility would expire after three years, when federal reimbursements for the program are scheduled to decline from 100 percent to 90 percent, unless the Legislature takes additional action.

More than 15,000 low-income parents are expected to lose coverage in January, when changes to MaineCare take effect. An additional 10,500 adults with no dependent children and incomes less than $11,500 will lose coverage.

The 10,500 childless adults fall into a loophole in the Affordable Care Act that makes them ineligible for federal subsidies for private insurance even if they’re not covered by Medicaid.

Democrats are hoping that the pending loss of MaineCare coverage for some Mainers will convince some Republican lawmakers to support the new proposal.

The event, although upstaged by the Medicaid debate, brought LePage full circle on the hospital debt issue. In 2010 he campaigned in front of Central Maine Medical Center, saying that repaying the debt would be a priority if he were elected.

The debt stemmed from unpaid Medicaid reimbursement payments from the state to the hospitals.

The Medicaid debt began accumulating years before Gov. John Baldacci took office in 2003. It has been attributed to a payment system that didn’t keep pace with hospitals’ Medicaid claims to the state.

Baldacci and the Legislature made payments that sent $3.7 billion to hospitals over the last decade, but not enough to erase the debt.

The Legislature approved LePage’s debt payback plan this year. Since then the governor has linked the hospital debt to the Medicaid debate. During prepared remarks he called the hospital debt “welfare debt.”

“These payments to hospitals are not a windfall,” he said in prepared remarks. “It is welfare debt owed for over a decade that the state of Maine is finally making good on.”

The wrinkle in Wednesday’s staged event marked another chapter in the ongoing public clash between LePage and Democrats — and another involving a big check. In May, moments after the Democratic-controlled Legislature passed the bill linking LePage’s hospital payback plan to Medicaid expansion, LePage and several Republican lawmakers quickly gathered in the State House Hall of Flags in front of the media to veto the bill. Democrats had reserved the Hall of Flags for a ceremonial bill signing that included a check made out to Maine’s hospitals, but LePage’s veto upstaged the event.

S. Donald Sussman, majority owner of MaineToday Media, which includes the Portland Press Herald, lists the alliance as one of 33 Maine organizations to which he has contributed.

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